Because of the prevalence and associated health-care costs of obesity, it is widely recognized today as a serious public health issue. The Affordable Care Act (ACA) passed in 2010 includes provisions for all adults to be screened and behavioral intervention offered to those with a body mass index (BMI) of > 30 kg/m2. While the measure is intended to improve access to weight-loss resources for millions of Americans affected, it may not achieve its intended effect in part because of the inability of disadvantaged populations for whom the burden of obesity is the greatest to access ACA-supported services. The objectives of this study were to identify the characteristics that, paired with an evidence-based weight-loss intervention, will have the highest potential reach while achieving a clinically meaningful weight loss, and whether likely participation differs by gender, race, ethnicity or socioeconomic status. Using characteristics from the most effective adult weight-loss studies that use technology to expand reach, three alternative interventions were examined. Findings show that, while the majority of participants favor the traditional ACA face-to-face model, a program delivered completely online may appeal to racial and ethnic minority groups, which were more likely to choose alternative program structures. Alternative program structures should continue to be explored as an important next step toward developing viable referral options for primary care physicians and could have far-reaching impact toward reducing the disparity of obesity and obesity-related disease among disadvantaged populations. / Master of Science / The majority of adults in the U.S. are overweight or obese, placing them at risk for serious health problems. Because of its prevalence and associated health-care costs, obesity is widely recognized today as a serious public health issue. The Affordable Care Act (ACA) passed in 2010 includes provisions for all adults to be screened and behavioral intervention offered to those with a body mass index (BMI) of ≥ 30 kg/m². While the measure is intended to improve access to weight-loss resources for millions of Americans with obesity, it may not achieve its intended effect for a variety of reasons, including the inability of disadvantaged populations for whom the burden of obesity is the greatest to engage in ACA-supported services. The objectives of this study were to identify the characteristics that, paired with an evidence-based weight-loss intervention, will have the highest potential reach while achieving a clinically meaningful weight loss, and whether likely participation in response to different characteristics differs by gender, race, ethnicity or socioeconomic status. Adult participants (n=185) from Omaha, Nebraska, were recruited to participate in a survey in which they were presented with a “basic” program based on ACA-covered features (e.g., 20 in-person weight loss sessions over a 6-month period) and three alternative programs that included feature enhancements: weight-loss medication (Program A), online delivery (Program B), and a combination of the two (Program C). Participants were asked to choose in which program they would be most likely to participate. Statistical analysis included cross tabulation by gender, race, ethnicity, education, income and BMI and chi square analyses to determine whether the differences between the sub groups were statistically significant. The sample (n=185) was predominantly female (73%), 42 percent of participants were black and 43 percent were Hispanic. The majority of the sample (84%) were overweight or obese (55% ≥ 30; 29%26≤29; 13%≤25). Ages ranged from 21 to 86 (mean age 47 +/-14/7). The majority of participants (88%) selected the ACA-based program over Program A (22%) regardless of participant attributes. Similarly, the majority selected ACA (70%; 81%) over Programs B (30%) and C (19%), respectively. Program selection by gender and weight status was not significantly different. The majority of participants selected the ACA-based program (81%;78%) over Program A (19%) and Program B (22%) regardless of race. However, when contrasting Program B with the ACA program, black participants (43%) were more likely white (21%) participants to select Program B (p<0.05). A similar pattern was found for Hispanic participants with non-Hispanics (42%; 28%) being significantly more likely to select Program B than Hispanic participants (16%; p<0.05). and Program C (8%; p<0.05). Upper income participants (40%) were more likely to select Program C over the ACA program when compared to both middle (18%, p<0.05) and lower household income (9%, p<0.05) participants. Finally, Participants with a college education or professional degree were more likely to select Program B (46%, p<0.05) and Program C (31% p<0.05), when compared to participants without a college degree (22%; 14%, respectively). The development of alternative program structures should continue to be explored among disadvantaged groups and evaluated to determine their appeal. Identifying the characteristics that paired with a structured, behaviorally based program achieve the highest reach while producing a clinically meaningful weight loss is an important next step toward developing viable referral options for primary care physicians and could have far-reaching impact as more Americans seek such services.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/78193 |
| Date | 13 June 2017 |
| Creators | Staley, Linda L. |
| Contributors | Human Nutrition, Foods, and Exercise, Davy, Brenda M., You, Wen, Frisard, Madlyn I., Estabrooks, Paul A. |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Detected Language | English |
| Type | Thesis |
| Format | ETD, application/pdf, application/pdf |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
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